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<br />ANNUAL FEE and REPORT REpUEST <br />RECEl~IED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Daniel M Russell <br />M-1995-034 <br />Bachus Pit <br />July 10, 2002 <br />JUL 1 0 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Alamosa <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator <br />shall submit the annual fee, a repott and map shuwing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permi[tee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daniel M. Russell <br />Permittee Name: <br />Address: <br />Daniel M Russell <br />9042 S. 106 Rd. <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-3004 <br />Fax Number. (719) 589-3712 <br />7/9- Sf~9- 300¢ EXf //U <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~7• <br />Signature of Co poste Of icer or Owner <br />~O Z <br />Date <br />M:~PCRM I'MA ASTFRDOCUMGNTSWI-Ar-01 <br />